3 July 2010

Wormwood and gall

Been silent for the last few days because I have been sampling the NHS at the nearby Lister Hospital.

No, not for research - last Saturday what appears to have been a long-term inflammation of my gall-bladder abruptly went from grumbling to intensely direct action, complete with a massive kidney infection and accompanied by my blood pressure dropping off a cliff - and pain, lots and lots of pain.

If hospitals want a no-holds barred assessment of the efficiency of the service they provide, they would be well-advised to run a borderline OCD like yours truly through the system from time to time. I hope to write an article on the very large number of perfectly evident, indeed screamingly obvious, procedural imbecilities, professional malpractice and life-threatening carelessness that forced themselves on my (admittedly bilious) attention during my time at the SSU.

I could a tale unfold whose lightest word
Would harrow up thy soul, freeze thy young blood,
Make thy two eyes, like stars, start from their spheres,
Thy knotted and combinéd locks to part
And each particular hair to stand on end,
Like quills upon the fretful porpentine.

And, in due course, I will. Anyway, yesterday a sonogram found a 3mm stone and a large amount of 'sludge' in my gall bladder, that my right kidney is smaller than my left and is in some other, unspecified way, suspect. The upshot is that mega-doses of antibiotics, plus gallons upon gallons of water later, I feel a great deal better.

The NHS remains clearly and entirely producer oriented. This is not unusual. I have prior personal experience of hospitals in Chile, Italy, Guatemala and several in the USA, and in all of them, mutatis mutandis, the same applies.

In the States, the medical staff are kept in check (and usually in the background) by the ever-present danger of malpractice suits, but elsewhere the arrogance of the MDs knows no limit other than their own sense of what is proper. But they do have a sense of what is proper - what is befitting.

This shows very clearly down the line. Nurses are smartly uniformed and emanate an aura of a corps d'élite, wards are clean, beds made up smartly, etc. Patients may be regarded, generally, as an untidy element in the practice of (fanfare) Medicine (declining ching of cymbals), but their annoying requests for help in getting in and out of bed, performing bodily functions and so on are dealt with swiftly and competently.

So - why can't "the envy of the world" do the same? I had a lot of time to brood on that and two factors stood out in stark clarity. The first is that you cannot find out who is ex officio responsible, at ward level, for anything involving interaction with patients. I asked three successive shifts of nurses who was in charge of the ward and none of them even understood the question. The same incomprehension greeted my queries about who was in charge (the most senior, I said) of the medical staff and of the nursing staff.

What I understood from their explanations is that everybody was collectively responsible for everything.

The second factor that most clearly differentiates "the envy of the world" from the lesser health care providers I have encountered in less blesséd societies is that the latter hum with a sense of purpose, whereas the word that most clearly applies to that part of the NHS I was compelled to observe for three days is: ENTROPY.